Adenomyosis Flashcards
What is adenomyosis?
A condition in which the inner lining of the uterus (endometrium) breaks through the muscle wall of the uterus (the myometrium)
Who is adenomyosis more common in?
Multiparous women near end of reproductive years
What symptoms can occur?
Dysmenorrhea - commonly progressive, beginning as cyclical pain, but can worsen to daily pain
Menorrhagia
Lower abdominal pressure
Bloating before menstrual periods
Pre menstrual pelvic pain, feeling of heaviness
Less common:
Pain related to bowel movements
Dyspareunia
Describe how the uterus is on examination
Enlarged and boggy
The condition can be located throughout the entire uterus or localised in one spot. True or false?
True
How is adenomyosis treated?
Symptomatic management:
IUS if contraception required - first line
Non hormonal - tranexamic acid, NSAIDS
Hormonal - COCP, cyclical oral progestogen
GnRH analogue - temporary menopause, can shrink the tissue
Uterine artery embolisation
Hysterectomy = the only curative therapy
How is it diagnosed?
Definitive = histology after hysterectomy
TV USS and MRI can detect signs
What are some common transvaginal US findings in those with adenomyosis?
Globular, enlarged and/ or asymmetric uterus
Abnormally dense or varied density of myometrium
Myometrial cysts
What does it frequently occur together with?
Fibroids
When do symptoms subside?
Post-menopause as they ectopic tissue is hormone responsive
What causes it?
When the endometrial tissue is allowed to communicate with the myometrium after uterine damage. May occur with:
Childbirth
C section
Uterine surgery
Surgical management of miscarriage or termination of pregnancy
What wall of the uterus is it most commonly found in?
Posterior wall
What risk factors are there?
High parity
Uterine surgery
Previous C section
Potential genetic predisposition
What differential diagnoses are there?
Endometriosis Fibroids Endometrial hyperplasia/carcinoma PID - pelvic pain rather than cyclical Hypothyroidism and coagulation disorders (menorrhagia)
